Sleep Disorders and neuropathy Rani Das, MD When did sleep - - PowerPoint PPT Presentation

Sleep Disorders and neuropathy Rani Das, MD

When did sleep disorders worsen in time? 1879!

Disturbed sleep can worsen your pain. It's a vicious cycle: pain prevents you from sleeping, and not sleeping makes the pain worse.

• The diagnosis and treatment of neuropathic pain

may be complicated by comorbid conditions such as sleep disturbances, depression, and anxiety

• Sleep onset insomnia can occur due to

anxiety,sleep fragmentation and disruption can be due to chronic pain which can lead to decreased tolerance for neuropathic pain

Obstructive Sleep Apnea

• Common symptoms are snoring and having pauses in

breathing in sleep

• Symptoms include tiredness, daytime sleepiness, feeling tired

after sleeping and morning headaches, arousals at night

• Graded in severity as AHI ( apnea hypopnea index)
• Treatment includes CPAP( Continuous positive airway

pressure)

• Risk factor for CAD, Stroke,HTN,CHF( Sleep Heart health

Study 2007-10)

Clinical Journal of Pain: October 2006 - Volume 22 - Issue 8 - pp 681-685 Zelman etall

• This study evaluated sleep impairment associated with painful

diabetic peripheral neuropathy (DPN), a neuropathic pain

• condition. Sleep is of critical concern for DPN because sleep

impairment and its comorbidities may influence type 2 diabetes

• Sleep Apnea can cause worsening of Diabetes and metabolic

syndrome which can cause progression of neuropathy

• It was found that insulin resistance is related to the severity of

sleep apnea ( journal of sleep medicine March 93)

• . It is assumed that recurrent intermittent

hypoxaemia (decreased oxygen level in blood)in OSA is an independent risk factor for axonal damage of peripheral nerves.( Case control study J Neurol Neurosurg Psychiatry 2001)

• Dysautonomia seen in autonomic neuropathy can

cause arrhythmias related to OSA

• Neuropathy can cause secondary Restless Leg

Syndrome

• urge to move your legs usually accompanied by

uncomfortable leg sensations

• symptoms are partially or totally relieved by

movement.

• symptoms begin or worsen during rest such as lying
• r sitting.
• symptoms are worse in the evening or night

Neuropathy meds and sleep

• opioids, and methadone in particular, have been found

to be associated with a high rate (75%) of obstructed breathing and central apnea in patients with chronic pain.

• Tricyclics suppress REM and decrease sleep latency
• SSRI/SNRI drugs like CYMBALTA suppress REM sleep
• Gabapentin ,lyrica increase N3 Sleep and cause less

sleep fragmentation

Insomnia

• Difficulty in falling asleep or staying asleep
• Difficulty falling asleep can be related to anxiety or just inability to relax
• Cognitive behavioral therapy helps , Yoga Nidra
• Trying to go to sleep makes insomnia,anxiety worse...your goal should

be never to make yourself go to sleep...only to relax

• Do not spend too much time in bed ( no more than 5-6 hrs)
• Don't watch the clock
• Regular bed schedule
• Difficulty staying asleep could be due to pain , or other sleep disorders

Insomnia

• If you do not fall asleep in 15-20 mts, go to another

room

• Try progressive muscle relation.breathing techniques,

sit in a easy chair and turn on soft light to read

• Avoid the computer or media
• You may like to play soft music
• Your goal is to do something quiet and relaxing

Sleep Habits that can help

• Stick to a regular bed time routine
• Get up at same time every day
• Avoid caffeine and alcohol
• Get daily exercise
• Make your bedroom quiet and dark
• Pets to sleep outside the bedroom if disruptive
• Keep the temperature cool ( 60-67 degrees) body temperature drops to initiate

sleep

• Avoid electronics before bedtime..orange filter sunglasses can help filter disruptive

blue light

Sleep Hygiene

• Avoid napping during the day. It can disturb the normal pattern of sleep and

wakefulness.

• Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime.

While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.

• Exercise can promote good sleep. Vigorous exercise should be taken in the

morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.

• Food can be disruptive right before sleep. Stay away from large meals close

to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it's not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.

• Ensure adequate exposure to natural light. This is

particularly important for people who may not venture

• utside as frequently as children and adults. Light

exposure helps maintain a healthy sleep-wake cycle.

• Establish a regular relaxing bedtime routine. Try to

avoid emotionally upsetting conversations and activities before to go to sleep. Don't dwell on, or bring your problems to bed.

• Associate your bed with sleep. It's not a good idea to

use your bed to watch TV, listen to the radio, or read.

• Have light exposure in daytime .Make your room dark

at night. Do not take naps in the day

• ( natural sunlight and dark ness effects sleep clock in

hypothalamus (SCN) which regulates melatonin by pineal gland ) to establish your circadian /sleep rhythm

• Consider timing of drugs like Gabapentin at night
• Talk to your doctor about over the counter meds which

may effect your sleep

Thank You